Provider Demographics
NPI:1184191793
Name:SMITH, CORIN (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:CORIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16871 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4088
Mailing Address - Country:US
Mailing Address - Phone:818-625-6078
Mailing Address - Fax:
Practice Address - Street 1:16871 HARVEST LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4088
Practice Address - Country:US
Practice Address - Phone:818-625-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered